Education Improves Understanding of Risks of Having Twins

Twin Pregnancy Risk

Parents who wish for IVF twins are often unaware of the risks involved in twin pregnancy and in giving birth to more than one child at a time, a scientist told the 22nd annual conference of the European Society of Human Reproduction and Embryology in Prague, Czech Republic, on Wednesday 21 June 2006. Dr. Ginny Ryan, from the Department of Obstetrics and Gynecology, University of Iowa, Iowa City, USA, said that educating potential parents in these risks was essential if problems were to be avoided.

"Along with many infertility specialists, we have been alarmed by the large numbers of twin pregnancies resulting from infertility treatment, and especially IVF", she said. "But we also noted that patients seemed much less concerned by twin pregnancies than we are and, indeed, many desire this outcome."

Dr. Ryan and her team had previously researched infertility patients' wishes for the outcome of pregnancies, and found that desire for multiple births was associated with having no previous children, lower family income, younger patient age, longer duration of fertility and lack of knowledge regarding the risk of having twins. The team decided to evaluate whether improving education on these risks could improve understanding and have an effect on IVF patients' desire for multiple pregnancies.

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110 couples took part and completed 2 questionnaires; after the first, which asked, among other things, how many children were desired from a pregnancy, a one page description of the risks of twins to the children and the mother was distributed and discussed. Afterwards, the questionnaire was completed again.

Following discussion of twin risks, significantly more patients ranked singletons as their most desired treatment outcome (86% as opposed to 69% first time round); and significantly fewer chose twins (14%, versus 29% first time round). "On both pre and post-education questionnaires, the most common reason for preferring twins was 'I want to reach my ideal family size more quickly'", said Dr. Ryan. "There was still a significant minority that preferred this option, even having been informed of the risks."

Dr. Ryan has been unable to study whether this increased theoretical desire to avoid twins by some patients has translated into action, since her IVF clinic has now instituted a mandatory policy of single embryo transfer. The team intend to follow this up by studying overall pregnancy and delivery rates, and twin rates, and by evaluating patient satisfaction with the new policy.

"The clash we have noted between patient desires for twins and physicians' concerns for twin risks comes at an interesting time for biomedical ethics", she said. "Patient autonomy has become the most valued ethical principle in today's medical decision-making process. However, doctors feel that their principles of non-maleficence